L.A. County health officials grilled over nursing home inspections

The Los Angeles County Board of Supervisors unanimously ordered an audit Tuesday of how the public health department oversees nursing homes, after a news report revealed that managers told inspectors to close cases without fully investigating them.

Expressing anger and shock, the supervisors summoned Department of Public Health Director Jonathan Fielding to the meeting to answer questions about the nursing home inspection process. During the heated discussion, Supervisor Mark Ridley-Thomas called for the audit.

“The gravity of the issue is hardly inconsequential when we think about the care for those individuals who are in an infirm state,” Ridley-Thomas said. “I do feel that the representations made by Dr. Fielding and his team need to be buttressed by a more careful and independent look.”

The supervisors questioned whether the county should continue the contract with the state to oversee nursing homes. Public health officials told them that there isn’t enough funding to do the job under the state’s requirements.

The unscheduled discussion, deemed “urgent” by the supervisors, followed a report on the handling of nursing home complaints by Kaiser Health News, which was published exclusively in the Los Angeles Daily News on Tuesday.

The report cited internal memorandums advising county inspectors and managers to close out certain cases without investigating them “fully” under a program public health department leaders called the “Complaint Clean Up Project.” These did not include cases of alleged abuse and neglect but involved other complaints that elderly advocates said are potentially serious.

During the lengthy question-and-answer session, the supervisors pressed Fielding about the thoroughness of the investigations and the reasons for an extensive backlog of cases.

Fielding insisted to the board that the cases had been investigated but acknowledged that the findings weren’t written up in final form.

“Every single complaint has been investigated and followed up,” Fielding told the board. “But we did that (investigating) in preference to finishing the paperwork of the reports when there wasn’t enough capacity to do both.”

Advertisement

In a subsequent interview, Fielding said the county was forced to prioritize cases because of insufficient funding from the state over the years. He said he was re-evaluating whether to continue the county’s contract with the state or whether to renegotiate to get additional resources.

Los Angeles County is unique in acting on the state’s behalf for nursing home oversight and Fielding said it was important to have local control. State inspectors conduct the reviews in the rest of the state.

“We have not been able to get sufficient funding for the state to accomplish all the things they are requiring of us,” Fielding said.

Fielding acknowledged in the interview that from August 2013 through last month, the department had not been following the state’s instructions on how to close “lower level” cases, which he said did not involve risk to patients. In those cases, the inspectors evaluated the specific allegations but did not do “a full, soup-to-nuts evaluation of the nursing home” as required by the state, he said.

The state considered that approach “inappropriate,” he said. “We have stopped it and it should not have been done.”

Michael Connors, an advocate with California Advocates for Nursing Home Reform, said he was skeptical that the county was doing the investigations thoroughly, adding that a completed report is critical to the process. “It is unbelievable to me that they investigated and didn’t complete them,” he said.

State Sen. Leland Yee, D-San Francisco, said neither Los Angeles County nor the state should use money as an excuse for shortchanging oversight of senior care.

“I think it’s rather embarrassing that the state of California cannot take care of some its most vulnerable residents as its seniors,” Yee said. “I just hope this is a wake-up call for the state of California that we have to change our attitudes.”

The California Department of Public Health, after previously saying there were about 9,000 open cases statewide, said late Monday it has determined there are in fact 4,725 outstanding cases. Of those, a substantial number are in Los Angeles County.

In February, the state asked L.A. County to submit a written plan and timeline by mid-March for addressing the county’s backlogged cases. “CDPH expects those timelines to reflect the needs of complete and thorough investigations according to state and federal protocols,” the letter said.

The state public health department began its own separate audit into the county’s process Monday morning, after instructing staff to immediately stop the “Complaint Clean Up Project.”

Under that project, according to internal county public health documents, Ernest Poolean, chief of the health facilities inspection division, advised staff to close certain cases, some of which may have dated to 2001. Complaints submitted anonymously were to be closed as “No Action Necessary,” the documents said.

In other cases, if two other inspections that were done around the same time did not reveal problems similar to the new allegation, the complaint was to be determined “unsubstantiated,” the documents indicated.

State public health spokeswoman Anita Gore said her department did not know about the county’s procedures before being questioned by a reporter from Kaiser Health News last week.

The county supervisors said they were taken aback by the news report, saying they only learned of it late Monday night when the public health department sent a letter alerting them to its publication.